Claim Spensley, Scott J.
CLAIM AGAINST THE CITY OF DUBUQUE, IOWA
This written report constitutes your claim against the City of Dubuque, Iowa. You should complete this form in full and attach any additional information that supports your claim.
The Claim must be filed with the City Clerk at City Hall, 50 W. 13th St., Dubuque, IA 52001. It will then be referred by the City Council to the appropriate department for investigation. Once that investigation is completed, a report and recommendation will be submitted to the City Council. You will be provided with a copy of that report and recommendation.
THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL. NO EMPLOYEE OF THE CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO YOU AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
1. Name of Claimant: Scott J. Spensley
2. Address: 380 Stoltz St. DBQ 52001
`
3. Telephone Number: 563 583 5861
4. Date of Incident: 10/10/03 & 10/08/03
5. Time of Incident: 10/8 - 7:30 PM; 10/10 - 9:00 A.M.
6. Location of Incident (Be specific): In the basement of my hosue, 380 Stoltz
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give full details upon which you base your claim. If a City employee was involved, give the employee's name.)
The City sewer backed up in the basement on both times listed flooding my basement with sewer water damaging my daughter's playroom carpet.
City Employee (Chapman (Witness)
8. What were weather conditions like? Sunny - Normal
9. Give name and address of any witnesses: Neighbor Roger Rollinger, 2999 Muscatine
10. Did police investigate? (If so, give names of officers.) No
11. Was anyone injured? (If so, give names, addresses, and extent of injuries). No
12. Was any damage done to property? (If so, describe property and the extent of damages. Attach estimates of damages or describe basis for ascertaining extent of damage.)
Just the carpet in the playroom, completely soaked with sewer water. The smell is terrible and the bacteria in the carpet. I cleaned it with a steam cleaner but the smell is still tehre and needs to be replaced immediately. There were other items
in the room damaged listed below.
13. What other damages do you claim, if any? Steam cleaner,
14. Have you been compensated for any part or all of your claim by any insurance company? (If so, give name and address of insurance company and amount paid.)
No
15. What amount do you claim from the City of Dubuque?
$879.00 cost of carpet and cleanup (not including other damaged items).
16. Why do you claim the City of Dubuque is responsible?
Because the City SEwer cloged and back up into my house, I'm not responsible for the City Sewer line.
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
No
18. If the answer to Question 17 is yes, have you received any payment from that source, and if so, in what amount?
Dated at Dubuque, Iowa this 5th day of November , 2003.
/s/ Scott J. Spensley
Other damaged items - daughter stuffed animals; VCR Player; Vacuum cleaner; Down mattress pad; 2 quilted blankets; all items were hauled to the City dump.
(Signature)
(Print Name)
(Rev. 1/00 & 7/01)
CLAIM A GAINSTTHE CITY OF D UBUQUE~IOWA '~-~~~-~ r--~-~,-
This written report constitutes your claim against the City of Dubuque, Iowa. You should
complete this form in full and attach any additional information that supports your claim.
Th~ Claim must be filed with the City Clerk at City Hall, 5(] W. 13th St., Dubuque, IA 52001.
It will then be referred by the City Council to the appropriate department for investigation.
Once that investigation is completed, a report and recommendation will be submitted to the
City Council. You will be provided with a copy of that report and recommendation.
THE FINAL DECISION ON ALL CLAIMS IS MADE BY THE CITY COUNCIL. NO EMPLOYEE
OF THE CITY OF DUBUQUE HAS THE AUTHORITY TO MAKE ANY REPRESENTATION TO
YOU AS TO WHETHER YOUR CLAIM WILL OR WILL NOT BE PAID.
1. Name of Claimant:
2. Address:
3. Telephone Number: ~/~ ~5 -5~6 /
4. Date of Incident:
5. Time of Incident: /O/X~
6. Location of Incident (Be specific):
7. DESCRIBE ACCIDENT OR OCCURRENCE THAT CAUSED INJURY OR DAMAGE. (Give
full details upon which you base your claim. If a City employee was involved, give the
employee',s name.),.
~J J / ~' ~ / ' ~ // ' "' , ~-L_[~b
8. What were weather conditions like? ~n~{/ ~or~ ~
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9. Give name and address of any witnesses: ~?y4~~ ~)¢r fi~f/'~_
10. Did police investigate? (If so, give names of officers.)
11. Was anyone injured? (If so, give names, addresses, and extent of injuries).
12. Was any damage done to property? (If so, describe property and the extent of dam/~ges".
Attach estimates of damages or describe basis for ascertaining extent of damage.)
13. What other damages do you claim, if any? ~'-/¢o,,~, (~/~.,~, . ./~/, ~ .l~/m .~'/~
14. ~ yuu ueen compensa[eQ tor any par[ or a o~ your c~mm Dy any insurance
company? (If so, give name and address of insurance company and amount paid.)
15. What amount do you claim from the City of Dubuque?
16. Why do you claim the City of Dubuque is responsible?
17. Have you made any claim against anyone else for damages as a result of this incident?
(If yes, give name and address.)
18, If the answer to Question 17 is yes, have you received any payment from that source,
and if so, in what amount?
Dated at Dubuque, Iowa this
(~ev. 1/00 & ~/01)
~---~ day of
STATEMENT
CHARGES
HERE'S THE PROBLEM I FOUND AND FIXED. sink .................................... $ '
YOUR; WAS CLOGGED BY:
[] sin~< FI grease
FI tub or shower FI food
FI toilet FI paber or sansary oroducts ,
Fl laundry ~ washer lines FI hair floor brain ........................... $
FI floor drain FI lint
FI seetic tank line FI tree roots . laundry ............................... ~', ·
FI main sewer line FI fore gn objects septic line ...........................
FI sludge
FI omer F~ seao residue'
"nam sewer ..................... $_,~.-~--~'~-~
~L FOG~GE C~EANE~ K~¥ES USED_
JOB DESCRIPTION AND REMARKS:
TOTAL
t ,:<,,:.? ,'v' ::
~'~,~C, USTOMER SIGNATURE ~ ~
A se~[ce charge of 1 1/2% per month (18% uer annum) will be cn;rgea to all accounts past
30 days. Costs plus reasonable attorney fees [o ue added in case of suit for ~ilecbon
INVOICE
299 E. 9TH ST.
DUGU(~UE, IA
(563) §88-2220
SOLD BY /- f'-~.~h'~' ,~-'-~.D. CHARGE" ~A~T~ ~SE. RET'D PAID OUT
977A
A c a ms'and returned geQd~
MUST be accompanied by th s bill.
Thank 7~/ou!
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